The night that Stephen Paddock opened fire on thousands of people at a Las Vegas country music concert, nearby Sunrise Hospital received more than 200 penetrating gunshot wound victims. Dr. Kevin Menes was the attending in charge of the ED that night, and thanks to his experience supporting a local SWAT team, he’d thought ahead about how he might mobilize his department in the event of a mass casualty incident.
This is his story, as told to Judith Tintinalli, MD, MS
Edited by Logan Plaster
I’m a night shift doc. My work week is Friday to Monday, 8 p.m. to 6 a.m. Most people don’t want to work those shifts. But that’s when most of the action comes in, so that’s when I work. It was a Sunday night when the EMS telemetry call came in to alert Sunrise Hospital of a mass casualty incident. All hospitals in Las Vegas are notified in a MCI to prepare for incoming patients.
As I listened to the tele, there happened to be a police officer who was there for an unrelated incident. I saw him looking at his radio. I asked him, “Hey. Is this real?” and he said, “Yeah, man.” I ran down to my car and grabbed my police radio. The first thing that I heard when I turned it on to the area command was officers yelling, “Automatic fire…country music concert.” Ten o’clock at night at an open air concert, automatic fire into 10-20 thousand people or more in an open field—that’s a lot of people who could get hurt.
At that point, I put into action a plan that I had thought of beforehand. It might sound odd, but I had thought about these problems well ahead of time because of the way I always approached resuscitations:
- Preplan ahead
- Ask hard questions
- Figure out solutions
- Mentally rehearse plans so that when the problem arrives, you don’t have to jump over a mental hurdle since the solution is already worked out
It’s an open secret that Las Vegas is a big target because of its large crowds. For years I had been planning how I would handle a MCI, but I rarely shared it because people might think I was crazy.
The first thing I did was tell the secretaries I needed every operating room open. I needed every scrub tech, every nurse, every perfusionist, every anesthesiologist, every surgeon—they all need to get here right away. They immediately began making phone calls. I told the trauma nurses that I needed all the treatment areas completely clear. Nurses were instructed to keep an eye out for crashing patients and make sure that all patients had bilateral 14-18 gauge IVs ready for the moment that they would decompensate.
We also initiated our hospital’s “code triage,” in which staff from upstairs would come down to help by bringing down gurneys and spare manpower. We took all of our empty ED beds and wheelchairs out into the ambulance bay. Anybody who could push a patient, from environmental services to EKG techs to CNAs, came out to the ambulance bay. I said to the staff, “I’ll call it out. I’ll tell you guys where to go, and you guys bring these people in.”
When the shooting started, there were four emergency physicians, one trauma surgeon, and a trauma resident in the ER. That night I was working with Dr. Patrick Flores and Dr. James Walker, two physicians I’ve worked with for over five years. We’ve gotten in trouble together many times for doing thoracotomies before the surgeon could arrive. I know how these guys work. We’ve done major resuscitations together. We are like brothers. We also had a new guy, Dr. Michael Tang, who just graduated residency and had been there for a few months. Dr. Allan MacIntyre was the Trauma Surgeon working that night.
Here is how our emergency department is laid out. Station 1 has a central desk with four trauma bays. Trauma 1 and 2 have two beds in each bay. Trauma 3 and 4 have one bed in each bay. The most critical care traumas usually go to Trauma 3 and 4. Also attached to Station 1 is our critical care pod. That has four beds in it. Adjacent to that is our psychiatric area where we fit eight beds close together. Station 2 is down the hallway from Station 1. Station 2 has a central nurse desk surrounded by eight beds that are in line of sight. Station 4 is the end of the hallway after Station 2. It opens up to a large room with a central desk with eight beds surrounding a wide U-shaped hallway. Taking the U-shaped hallway of Station 4 all the way around will lead you to the Med Room to the left, Rapid Track, and Station 3 to the right. The Med Room is an open room with recliners typically used to give medications. Rapid Track is a row of chairs in the hallway. Station 3 has multiple “Death Beds,” rooms that are isolated and private rooms with a door, out of line of sight from the nurse’s desk. In my mind, that was the worst place to put any of these traumas, so I told the nurses to not put anybody into those rooms.